NPIMap

Organization Active NPI

Student

  • Physician Assistant
  • Redlands, CA
National Provider Identifier
1174079347
Registry record updated Aug 28, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
Legal business name
STUDENT
Practice address
1640 Juanita LN
Redlands, CA 92373-7142
Phone
(951) 756-8989
NPI assigned
Aug 28, 2016
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 28, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Cullen Mack
Title
Student
Phone
(951) 756-8989

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician AssistantGroup: 193200000X MULTI-SPECIALTY GROUP 363A00000X Primary

Addresses

Primary practice location

1640 Juanita LN
Redlands, CA 92373-7142

Mailing address

1640 Juanita LN
Redlands, CA 92373-7142
Phone (951) 756-8989

National Provider Directory

National Provider Directory
Tax ID family
Metro Nashville Public Health Dept103 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1472342400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1472342400000",
    "number": "1174079347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1640 JUANITA LN",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923737142",
            "telephone_number": "951-756-8989"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1640 JUANITA LN",
            "city": "REDLANDS",
            "state": "CA",
            "postal_code": "923737142",
            "telephone_number": "951-756-8989"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STUDENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-08-28",
        "last_updated": "2016-08-28",
        "status": "A",
        "authorized_official_last_name": "MACK",
        "authorized_official_first_name": "CULLEN",
        "authorized_official_title_or_position": "STUDENT",
        "authorized_official_telephone_number": "951-756-8989",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Redlands, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.